A randomised controlled trial of metronidazole for the prevention of preterm birth in women positive for cervicovaginal fetal fibronectin: the PREMET Study by Shennan <i>et al.</i>

Lamont, Ronnie; Dragovic, B

doi:10.1111/j.1471-0528.2006.00958.x

Cited by 42 publications

(5 citation statements)

References 5 publications

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“…Such indications would not place a subsequent pregnancy at risk of infection-related PTB and consequently are unlikely to benefit from antibiotic prophylaxis. Such studies ( 104 ), have been erroneously cited as evidence that antibiotics have no role in the prevention of PTB ( 105 ). Only a small portion of such women (even those with BV) may be at risk for PTB.…”

Section: Antibiotics For the Prevention Of Infection-related Preterm mentioning

confidence: 99%

Advances in the Prevention of Infection-Related Preterm Birth

Lamont

2015

Front. Immunol.

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Infection-related preterm birth (PTB) is more common at early gestational ages and is associated with major neonatal mortality and morbidity. Abnormal genital tract microflora in early pregnancy predicts late miscarriage and early PTB. Accordingly, it is logical to consider antibiotics as an intervention. Unfortunately, the conclusions of systematic reviews and meta-analyses (SR&MAs) carried out in an attempt to explain the confusion over the heterogeneity of individual studies are flawed by the fact that undue reliance was placed on studies which: (a) had a suboptimal choice of antibiotic (mainly metronidazole) or used antibiotics not recommended for the treatment of bacterial vaginosis (BV) or BV-related organisms; (b) used antibiotics too late in pregnancy to influence outcome (23–27 weeks); and (c) included women whose risk of PTB was not due to abnormal genital tract colonization and hence unlikely to respond to antibiotics. These risks included: (a) previous PTB of indeterminate etiology; (b) low weight/body mass index; or (c) detection of fetal fibronectin, ureaplasmas, Group B streptococcus or Trichomonas vaginalis). While individual studies have found benefit of antibiotic intervention for the prevention of PTB, in meta-analyses these effects have been negated by large methodologically flawed studies with negative results. As a result, many clinicians think that any antibiotic given at any time in pregnancy to any woman at risk of PTB will cause more harm than good. Recently, a more focused SR&MA has demonstrated that antibiotics active against BV-related organisms, used in women whose risk of PTB is due to abnormal microflora, and used early in pregnancy before irreversible inflammatory damage has occurred, can reduce the rate of PTB. This review presents those data, the background and attempts to explain the confusion using new information from culture-independent molecular-based techniques. It also gives guidance on the structure of putative future antibiotic intervention studies.

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Section: Antibiotics For the Prevention Of Infection-related Preterm mentioning

confidence: 99%

Advances in the Prevention of Infection-Related Preterm Birth

Lamont

2015

Front. Immunol.

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“…Many authors consider abnormal flora and BV a risk factor for preterm delivery (13,16,17); however, most women with BV deliver at term. Other studies demonstrate that in a low risk population, BV did not increase preterm birth risk (18,19), and in a large randomised, placebo, controlled trial, the treatment with metronidazole of asymptomatic BV in pregnant women did not reduce the risk of preterm delivery or adverse perinatal outcomes (20,21). However, some recent studies using clindamycin early in pregnancy (22) showed a convincing reduction of preterm birth rate.…”

Section: Discussionmentioning

confidence: 98%

Placental histological inflammation and reproductive tract infections in a low risk pregnant population in Latvia

Rezeberga

Lazdāne

Kroiča

et al. 2008

Acta Obstet Gynecol Scand

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“…We would like to thank Lamont and Dravonic for their interest in our article and their valuable contribution. 1 We agree that the PREMET article should not be cited as evidence that antibiotics have no benefit in preventing preterm birth. However, we do believe that there is little evidence to support antibiotic use for this purpose in asymptomatic women.…”

Section: Sirmentioning

confidence: 96%

“…We would like to thank Lamont and Dravonic for their interest in our article and their valuable contribution 1 . We agree that the PREMET article should not be cited as evidence that antibiotics have no benefit in preventing preterm birth.…”

mentioning

confidence: 87%

“…Lamont and Dravonic report three trials that show benefit with clindamycin. 1 However, one must be sceptical regarding the antimicrobial benefit from one of these studies 2 as there was a statistically significant 40% reduction in preterm birth not related to antibiotic use, and this benefit was still apparent in the 80% of the 'revealed swab result' arm not receiving antibiotics, who had normal flora. Benefit is therefore more likely to be related to other factors, as suggested by the authors.…”

Section: Sirmentioning

confidence: 99%

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